Recognizing the warning signs of suicidal behavior and how to get help

Caring for someone experiencing mental health issues can leave you with a lot of questions.

What is a crisis point? What do you do if you suspect that the person you are caring for is suicidal? What do you do if they tell you that they have been thinking about suicide? What are the warning signs of suicide?  When do you need to call 9-1-1? What do you do and say while waiting for emergency help to arrive?

If you already have some concerns and questions, you may find it helpful to be proactive and knowledgeable about crisis management before a crisis occurs. Hopefully the information in this blog post will answer some of your questions and point you in the right direction to get the professional help the person in your care needs.

Caregivers and family members are often the first to notice when a person is in crisis and needs immediate support.  When someone has a mental health condition like depression or PTSD) and there is abuse of alcohol or drugs, there is a greater risk of suicide. There is also an increase in suicidal behaviour in those who have experienced the suicide death of a friend, colleague, family member, or someone they closely identified with. Please also keep in mind that these signs are not foolproof – someone could seem “just fine” and still be suicidal.

While there are risk factors, there is no single cause or reason to explain why someone would want to take their own life. The best thing you can do as a caregiver is educate yourself about myths, warning signs, and what you can do if you are worried or concerned that someone in your life is suicidal.

Myths about suicide

Myth: Talking about suicide creates suicidal thoughts.

Truth: Asking someone if they are having suicidal thoughts DOES NOT put the idea in their head. It is either already there or  it  is not. Talking about it does not invite suicidal thoughts or increase the risk of these thoughts.

Myth: If someone wants to die by suicide, there is nothing you can do.

Truth: Suicide can be prevented. Most suicidal thoughts are related to a chronic illness or injury that is treatable and there are often acute moments of a crisis where interventions can be effective. At the same time, it is equally important to know that you are never responsible if someone ends their life.

Myth: Not all threats of suicide or self-harm need to be taken seriously. Some people just talk about suicide to get attention.

Truth: All threats need to be taken seriously.

Myth: People with thoughts of suicide are weak in character.

Truth: Even the strongest individuals can experience suicidal thoughts. Suicidal thoughts and behaviour are a response to overwhelming distress or unbearable pain.

Suicide warning signs

While not every person will show signs of an intention to kill themselves or express an intention to harm themselves, there are certain signs and behaviours that indicate the person may be considering suicide. These warning signs have been simplified into a mnemonic ‘IS PATH WARM’ by the American Association of Suicidology, 

I     Ideation: Suicidal thoughts or talk of suicide are major warning signs for suicide.

S     Substance Use: Substance use lowers inhibitions and increases impulsivity. Suicide can be an impulsive act that follows the use of substances.

P     Purposelessness: Feeling that life is not worth living or no sense of purpose in life.

A    Anxiety/Agitation: Unable to sleep or sleeping all of the time.

T     Trapped: Feeling like there is no way out of the current situation.

H    Hopelessness: The future feels hopeless with little chance for positive change or improvement.

W   Withdrawal: Withdrawal from family, friends, and/or activities.

A     Anger: Rage, uncontrolled anger, or seeking revenge against others perceived to be at fault for the current situation(s) or problem(s).

R     Recklessness: Engaging in risky activities.

M    Mood Changes: Dramatic mood shifts or states.

If you believe that the person you are caring for is in immediate danger, that is, they have an intention to kill themselves, they have a plan, and they have the means (they have what is needed to take their life, such as a weapon or pills, for example) seek emergency help immediately by calling 9-1-1.

Please note that some of the warning signs listed above are also symptoms of mental health conditions such as depression and PTSD. This can complicate an already complex situation. Be careful about jumping to the conclusion that the person is suicidal. These are warning signs that suggest the person may be suicidal and may need help.

Suicide prevention — what can you do?

• Have a conversation

• Remember that talking to someone about suicide and asking them if they are thinking about suicide does not make them suicidal. Ask them if they are feeling helpless or hopeless. Ask them directly if they are thinking about killing themselves or having thoughts of suicide.
• The essence of this conversation is empathic listening and being supportive.  Empathy is often enough for the moment. They could potentially feel less alone and a little more hopeful.
• You want to be sure to neither judge nor minimize their feelings. While tempting, you want to avoid telling them what to do or persuading them that suicide isn’t the right option (this further isolates them).
• Be as calm as possible. Your calmness can help them feel calmer. You can “hold” the    hope for them and convey the message that help is available.

• Safety planning

• If they are having suicidal thoughts, you can ask if they have a plan (how? when? and where?). If the person is having suicidal thoughts and has access to the means (e.g. access to weapons) to kill themselves, you want to try and remove access to the means if possible and if safe to do so. If there are drugs and alcohol involved, try to help the person to agree not to take any more in this moment and if safe to do so, take them away. It is crucial that you keep your own safety and the safety of your family in mind. If it is unsafe, immediately call 9-1-1.
• Try to help the person to agree to not kill themselves for a manageable period of time. This manageable period is typically the period of time it takes for a response to a 9-1-1 call, a connection to a crisis line, getting to the nearest emergency department, or contacting other resources and professional help that are trusted and respected by the person (e.g. clergy, or another person who has been suicidal themselves and sought help).
• Help them get connected or reconnected with the above resources.  Stay with them until this connection takes place (in other words, do not leave them alone unless you feel in danger of being harmed or they are threatening you).

As a caregiver you can play a significant role in supporting someone who is suicidal, and can be a key to overcoming the stigma as well as encouraging them to seek professional help. The stigma which surrounds suicide continues to be a barrier to obtaining this help, which is why having a conversation can be a powerful intervention.

If the person you are caring for tells you that they are not suicidal, it does not make having the conversation a mistake. You have taken an opportunity to show that you care and are concerned about how they are doing. Let the person you are caring for know that you are there for them should a crisis arise in the future. Keep a list of crisis resources in a convenient location so that they can be easily accessed if needed.

Knowing how to deal with a mental health crisis such as suicidal behaviour can reduce your stress as a caregiver. At the same time, it is an extraordinarily stressful event and it may even be an ongoing stressful issue for you. Taking care of yourself and reaching out to for your own support and help is not just advisable, it is necessary for your own well-being.

For additional reading and resources, visit the Canadian Mental Health Association.